Provider Demographics
NPI:1336204346
Name:SUKIASYAN, ARSEN (DDS)
Entity type:Individual
Prefix:
First Name:ARSEN
Middle Name:
Last Name:SUKIASYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 GROVE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3137
Mailing Address - Country:US
Mailing Address - Phone:909-291-8625
Mailing Address - Fax:909-291-8629
Practice Address - Street 1:8283 GROVE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3137
Practice Address - Country:US
Practice Address - Phone:909-291-8625
Practice Address - Fax:909-291-8629
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92938Medicaid